Assessment and Diagnosis of the Psychiatric Patient

A sensitively crafted intake assessment can be a powerful therapeutic tool. It can establish rapport between patient and therapist, further the therapeutic alliance, alleviate anxiety, provide reassurance, and facilitate the flow of information necessary for an accurate diagnosis and appropriate treatment plan.

—Pamela Bjorklund, clinical psychologist

Whether you are treating patients for physical ailments or clients for mental health issues, the assessment process is an inextricable part of health care. To properly diagnose clients and develop treatment plans, you must have a strong foundation in assessment. This includes a working knowledge of assessments that are available to aid in diagnosis, how to use these assessments, and how to select the most appropriate assessment based on a client’s presentation.

This week, as you explore assessment and diagnosis of patients in mental health settings, you examine assessment tools, including their psychometric properties and appropriate uses. You also familiarize yourself with the DSM-5 classification system.

Objectives

 

·  Evaluate elements of the psychiatric interview, history, and examination, psychometric properties of psychiatric rating scales

· Justify appropriate use of psychiatric rating scales in advanced practice nursing

Getting Started With the DSM-5

If you were to give a box of 100 different photographs to 10 people. And ask them to sort them into groups, it is very unlikely that all 10 people would sort them into the exact same groups. However, if you were to give them a series of questions. Or a classification system to use, the chances that all 10 people sort them exactly the same increases depending on the specificity of the system. And the knowledge of those sorting the photographs.

 

This is not unlike what has occurred in the process of classifying mental disorders. A system that provides enough specificity to appropriately classify a large variety of mental disorders while also attempting to include all of the possible symptoms. Many of which can change over time, is a daunting task when used by a variety of specialists, doctors. And other professionals with varied experience, cultures, expertise, and beliefs. The DSM has undergone many transformations since it was first published in 1952. Many of these changes occurred because the uses for the DSM changed. However, the greatest changes began with the use of extensive empirical research to guide the creation of the classification system and its continued revisions.

Diagnostic and Statistical Manual of Mental Disorders

In order to assess and diagnose patients, you must learn to use the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, usually abbreviated as the DSM-5, to render a diagnosis. In this second week of the course, you will examine how DSM-5 is organized and how clinicians use it to render diagnoses.

Review the Learning Resources this week, with special emphasis on viewing the Diagnostic Criteria video. This video explains the purpose and organization of the DSM-5 classification system, the purpose of the ICD-10 coding system, their relationship to one another, and the importance to the PMHNP role.

 

Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

Assessment tools have two primary purposes: 1) to measure illness and diagnose clients. And 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor. Consider its use in psychotherapy.

To Prepare:

· Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.

· Consider the elements of the psychiatric interview, history, and examination, assessment tool assigned to you by the Course Instructor.

By Day 3 of Week 2

Explain: three important components of the psychiatric interview.

1. Why you consider these elements important.

2. Explain the psychometric properties of the rating scale you were assigned.

3. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview. And how the scale is helpful to a nurse practitioner’s psychiatric assessment.

Support your approach with evidence-based literature.

You are required to include at least 5 evidence-based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 6th edition formatting.